by Bruce Leon

Health care got short shrift this time around. But it could be one of the main issues in 2004. Here are the major initiatives on deck.

During the 2000 Presidential election, surveys showed that health-care-related issues ranked third among the most important topics on voters' minds. Considering that the crisis in health-care has increased significantly since 2000 and the number of uninsured is up nearly 25%, you would think that health care would have been a major topic in the midterm elections last week. But with a possible war looming on the horizon and the economy in the doldrums, voters placed little or no emphasis on health-care issues. However, lest anyone gets too complacent, with an aging population and pharmacy and medical costs skyrocketing, it is very likely this could become the prominent issue in the 2004 elections. For this reason, it is likely that the current Congress, along with a number of states, will work hard to come up with some bipartisan bills to address the current crisis.

One of the most ironic and certainly tragic events of this political season was the death of Senator Paul Wellstone (D-MN) in a plane crash 10 days before the elections. Senator Wellstone was an outspoken liberal and a champion for single payer (national) health-care reform. He had been ahead in some polls, but his replacement, former Vice-President Walter Mondale, was defeated narrowly by Republican Norm Coleman, which insured the Senate would move to Republican control. There was a theory that the Democratic controlled Senate would try to quickly pass a Healthcare Parity Bill during the lame-duck session as a memorial gesture to Senator Wellstone. This became unlikely after Governor Jesse Ventura appointed a conservative independent to replace Wellstone.

Another closely watched voter initiative was a bill in Oregon (Measure 23), which would have created a "single payer" health-care system that would have effectively replaced employer-sponsored plans. Benefits would be all-encompassing: whatever treatment a physician or recognized health professional prescribes would be covered at no cost to the patient. The benefits would be administered by a statewide board and funded by income taxes paid by individuals (47% of new costs) and employers (53% of new costs). The measure was touted by a number of consumer advocacy groups and labor unions. The measure was soundly defeated 79% to 21% and should act as a barometer on a national level: While Americans want to improve the current employer-based system, they aren't interested in a complete overhaul.

The five major bills that will be worked on this session are: Patients Bill of Rights, Tax Credits for the Uninsured, Tort Reform (Medical Liability), Antitrust waivers for Physicians, and off-course Pharmacy Benefits for Medicare participants. The version of the Patient's Bill of Rights that looks to make managed care most patient-friendly has already been enacted in many states. More than 90% of medical plans use some form of managed care and 23% receive benefits from HMOs. The Democrats want to allow patients the right to sue plan sponsors, which effectively would be a deathblow to HMOs. A compromise is likely, with a final bill expanding appeal rights and mandating certain coverages.

Help For The Uninsured

Tax credits for the uninsured has been a pet project of President Bush and one that will get more attention as the ranks of the uninsured grow. While this is a good idea, it doesn't solve the real problem of many uninsured, the inability to secure coverage at any price. However, since both sides of the aisle now support this issue, look for this to pass this session as well. Tort reform would limit damages ($250,000), limit attorney fees, pay damages over time, and limit class action suits. Of course, the trial attorneys oppose this vehemently, and since most legislators are lawyers, I believe it is doubtful any tort reform will be passed even though it is extremely necessary. The same applies to antitrust waivers for physicians, which would give physicians the ability to bargain collectively for fee-based contracts. Currently, antitrust laws prohibit this activity.

Perhaps the most attention will be given to seniors who want desperately to have prescriptions covered by Medicare. Most politicians favor some form of coverage, but controlling the cost is the main difficulty. Many people over 65 stay on employer plans solely for prescription benefits. I believe a limited benefit, phased in over time, may have a chance in this Congress.

Certainly, the rapidly increasing cost in health care is an important issue to both business and labor. There are no easy answers, but it is imperative for our economy that we work on solutions.